Basic Information
| Provider Information | |||||||||
| NPI: | 1275957557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOWER LIGHTS CHRISTIAN HEALTH CENTER, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNION STAR HEALTH CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142741455 | ||||||||
| FaxNumber: | 6142722333 | ||||||||
| Practice Location | |||||||||
| Address1: | 773 S WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430401643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142741455 | ||||||||
| FaxNumber: | 6142722333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2014 | ||||||||
| LastUpdateDate: | 08/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | VALLANGEON | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6142741455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.